Transcript Nursing Care of Older Adults

Nursing Care of Older
Adults
Janet Duffey, RN, MS, APRN, BC
Aging Populations
Demographics
Population trends: Aging baby boomers
Health care system projections
Distinguishing characteristics
Aging & Ageism
 Youth culture
 Stereotypes of elderly
 Minimization of
functionality
 Focus of some theories on
aging
 Verbal statements
 Non-verbal
Why do we age? Biological
theories on aging
 Cross linking
 Free radicals
 Neuroendocrine
 Autoimmune
reactions
Psychosocial Theories
Disengagement
Activity
Continuity
Age stratification
Implications of Aging Theories
Past experiences in life
Health beliefs & values
Adjustment to limitations
Indications for wellness
Changes view of aging equates to illness
Cultural Interpretation of Aging
 Physical traits
 Functional
 Symbolic
 Numeric age
 Status
 Role of aged individuals
 Meaning of aging
 Expectations of aging
experience
Aging
 Personal philosophy
 Societal view
 Caregiving systems
 Impact of ageism, on
clients, individuals &
nursing
Factors influencing health and
aging: Positive or Negative
 Culture
 Ethnicity
 Stress management resiliency
 Coping abilities
Contributors to Health
Alterations
 Excessive stress
 Underlying disease(s)
 Nutritional deficits
 Drug induced effects
 Falls and trauma
Health Promotion
 "... A multidimensional
pattern of self-initiated
actions and
perceptions that serve
to maintain or enhance
the level of wellness."
Pender
Health Promotion Activities
 Health assessment
 Support esteem in appearance
 Physical activity
 Retirement (pro and con)
 Part-time employment or volunteer
 Social activity
 Social support
 Support sexuality
Nursing in Geriatric Settings
 Uses the nursing process in ongoing
manner, not just one time
 Contributes to the treatment team
 Data systematically collected, ongoing
 Nursing diagnoses derived from
assessment
 NCP developed with patient and
significant other and problems
prioritized
Health Promotion Activities
 Enc. and facilitate participation in plan
 Give choices: food, grooming, activities
 Facilitate care in least restrictive setting
 Explore opportunities in community
 Anticipate changes in mental and physical
health
Legal Issues Associated With
Aging
 Consent for treatment
 Establishing competence
 Use of restraints
 Injuries
 Consent for participation in
research
 Maintenance of patient rights
 Advanced directives
 Do not resuscitate orders
Elder Abuse
 “Elder maltreatment" refers to the seven types
of abuse and neglect are physical abuse, sexual
abuse, emotional or psychological abuse,
financial or material exploitation, abandonment,
neglect, and self-neglect.
 At risk: female, frail, 80+, dependent on child or
spouse
 Mandatory reporting yielded 18% of all
reports, families
Alterations in Sensory
Function
Vision Changes
 Accommodation
 Narrowed visual field
decreased at periphery
 Opacity of lens
 Steropsis
 Altered color perception
 Light sensitivity
 Macular degeneration
Assessing Vision
History
Near focus
Distance vision
Peripheral testing
General assessment of function / ADLs and
IADL’s
Cataracts
Interim lenses
Anticipate post-op course
Intraocular-lens implants
Precautions
Avoidance of increased intraoccular
pressure
Antibiotic / anti-inflammatory eye drops
Alteration in Hearing
Functional, emotional, social impact
Affects 28-55% older adults
Presbycusis: bilateral, gradual decline
Sensoryneural type of impairment
Volume and high frequency consonants
Assessment of Hearing
 Onset
 Watch test
 Speech discrimination: fair,
sun, skies, shout, fun, sun
 Conversational responses
 Secondary complaints:
tinnitus, pain, conversational
difficulties
Interventions for Hearing
Impairment
 Determine presence of hearing difficulty
 Encourage acceptance and USE of hearing
devices
 Analog aids
 Digital programmed aids
 Radio / television devices
 Telephones
 Maintenance
Hearing Aid Batteries
Verbal Communication
 Slightly slower rate
 Increase volume with moderation
 Get patient's attention before
speaking
 Shorter sentences
 Lower voice pitch
 Remove distractions
 Provide information visually
 Non-verbal communication
 Identify denial/embarrassment
Touch & Older Adults
 Increased need
 Assessment by functional
measures
 Sharp / dull response
 Protective measures
 Emotional responses
Alteration in Taste & Smell
 Atrophy of papillae
 Preference of high
sugar & salty foods
 Cost
 Ability to chew food
 Poor oral hygiene
 Medications
Altered Olfactory Function
 Smell impacted by
lifestyle
 Sinus infections
 Related to head injury,
CVA, tumors
 Affects ability to enjoy
food, environment
 Monitoring function
essential for safety